Stroke is a debilitating illness affecting millions of individuals across the globe. While effective and life-saving treatment modalities exist at a majority of stroke receiving centers in the form of IV thrombolytics, there is an emerging new standard in acute ischemic stroke with mechanical thrombectomy.
Since 2015, when multiple clinical trials were published showing the efficacy of endovascular thrombectomy (EVT) for large vessel occlusion within six hours of stroke onset, additional criteria have been developed to identify those patients who will benefit from EVT beyond six hours. The AURORA investigators collected patient data from six large clinical trials and performed a meta-analysis to determine if a clinical mismatch or an imaging mismatch protocol was better at predicting good outcomes in patients treated between six hours and 24 hours after the onset of clinical stroke symptoms.
Real-time video conferencing between the patient, a remotely located stroke specialist, and the bedside healthcare provider in a hospital emergency department is referred to as “telestroke.” However, there are little data comparing its benefit with in-person evaluation and treatment for hospitals that do not have in-hospital stroke specialists 24 hours per day, seven days per week.
Since the first cases of COVID-19 were reported in the United States, severe ischemic strokes also have been reported in some of these patients, some with large vessel occlusions and case reports of thrombectomy for treatment.
Endovascular mechanical thrombectomy has become the standard treatment for patients with acute ischemic stroke caused by large vessel occlusion in both the anterior and posterior circulations. This is predicated on the ability to perform the procedure in a timely fashion or based on a mismatch between the size of infarction and brain perfusion.
These reviews of studies presented at the 2020 International Stroke Conference were written by Neurology Alert's editor after personal attendance at the presentations, followed by review of the simultaneous publications in Stroke. All comments and opinions are solely those of the editor.
Bridging therapy with intravenous thrombolysis appears to be associated with improved functional outcome without any additional complications compared to direct mechanical thrombectomy for patients with acute ischemic stroke who have LVOs.
Message from the editor: The following reviews of studies presented at the 2018 International Stroke Conference were written after my personal attendance at the presentations, followed by review of the simultaneous publications in the journals Stroke, The New England Journal of Medicine, JAMA Neurology, and the Journal of the American Medical Association.